Chapter 26 Birth-Related Procedures My Nursing Test Banks

Olds Maternal-Newborn Nursing and Womens Health, 10e (Davidson)

Chapter 26 Birth-Related Procedures

1) The client is undergoing an emergency cesarean birth for fetal bradycardia. The clients partner has not been allowed into the operating room. What can the nurse do to alleviate the partners emotional distress?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Allow the partner to wheel the babys crib to the newborn nursery.

2. Allow the partner to be near the operating room where the newborns first cry can be heard.

3. Have the partner wait in the clients postpartum room.

4. Encourage the partner to be in the nursery for the initial assessment.

5. Teach the partner how to take the clients blood pressure.

Answer: 1, 2, 4

Explanation: 1. Effective measures include allowing the partner to take the baby to the nursery.

2. Effective measures include allowing the partner to be in a place near the operating room, where the newborns first cry can be heard.

4. Effective measures include involving the partner in postpartum care in the recovery room.

Page Ref: 646

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Coping Mechanisms

Standards: QSEN Competencies: I. C. 13. Acknowledge the tension that may exist between patient rights and the organizational responsibility for professional, ethical care. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9 Explain the indications for cesarean birth, impact on the family unit, preparation and teaching needs, and associated nursing management.

MNL LO: 3.5.2 Explain the management of the childbearing family undergoing a cesarean birth.

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2) The client tells the nurse that she has come to the hospital so that her babys position can be changed. The nurse would begin to organize the supplies needed to perform which procedure?

1. A version

2. An amniotomy

3. Leopold maneuvers

4. A ballottement

Answer: 1

Explanation: 1. Version, or turning the fetus, is a procedure used to change the fetal presentation by abdominal or intrauterine manipulation.

Page Ref: 621

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: I. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2 Contrast the methods of external cephalic version and internal version and the related nursing management.

MNL LO: 3.5.4 Describe external version, its indications, and associated nursing considerations.

3) A woman has been admitted for an external version. She has completed an ultrasound exam and is attached to the fetal monitor. Prior to the procedure, why will terbutaline be administered?

1. To provide analgesia

2. To relax the uterus

3. To induce labor

4. To prevent hemorrhage

Answer: 2

Explanation: 2. Terbutaline is administered to achieve uterine relaxation.

Page Ref: 624

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2 Contrast the methods of external cephalic version and internal version and the related nursing management.

MNL LO: 3.5.4 Describe external version, its indications, and associated nursing considerations.

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4) The nurse is scheduling a client for an external cephalic version (ECV). Which finding in the clients chart requires immediate intervention?

1. Previous birth by cesarean

2. Frank breech ballotable

3. 37 weeks, complete breech

4. Failed ECV last week

Answer: 1

Explanation: 1. Any previous uterine scar is a contraindication to ECV. Prior scarring of the uterus may increase the risk of uterine tearing or uterine rupture.

Page Ref: 623, 624

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2 Contrast the methods of external cephalic version and internal version and the related nursing management.

MNL LO: 3.5.4 Describe external version, its indications, and associated nursing considerations.

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5) A woman is scheduled to have an external version for a breech presentation. The nurse carefully reviews the clients chart for contraindications to this procedure, including which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Station -2

2. 38 weeks gestation

3. Abnormal fetal heart rate and tracing

4. Previous cesarean section

5. Rupture of membranes

Answer: 3, 4, 5

Explanation: 3. An abnormal fetal heart rate or tracing would be a contraindication to performing a version. A nonreassuring FHR pattern might indicate that the fetus is already stressed and other action needs to be taken.

4. A previous cesarean is a contraindication for version.

5. Rupture of membranes is a contraindication for version because of insufficient amniotic fluid.

Page Ref: 623, 624

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2 Contrast the methods of external cephalic version and internal version and the related nursing management.

MNL LO: 3.5.4 Describe external version, its indications, and associated nursing considerations.

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6) A laboring clients obstetrician has suggested amniotomy as a method for inducing labor. Which assessment(s) must be made just before the amniotomy is performed?

1. Maternal temperature, BP, and pulse

2. Estimation of fetal birth weight

3. Fetal presentation, position, and station

4. Biparietal diameter

Answer: 3

Explanation: 3. Before an amniotomy is performed, the fetus is assessed for presentation, position, station, and FHR.

Page Ref: 633

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3 Discuss the use of amniotomy in current maternal-newborn care.

MNL LO: 3.5.1 Discuss methods of labor induction and augmentation including implications for nursing care.

7) Amniotomy as a method of labor induction has which of the following advantages?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. The danger of a prolapsed cord is decreased.

2. There is usually no risk of hypertonus or rupture of the uterus.

3. The intervention can cause a decrease in pain.

4. The color and composition of amniotic fluid can be evaluated.

5. The contractions elicited are similar to those of spontaneous labor.

Answer: 2, 4, 5

Explanation: 2. There is usually no risk of hypertonus or rupture of the uterus and this is an advantage of amniotomy.

4. The color and composition of amniotic fluid can be evaluated and this is an advantage of amniotomy.

5. The contractions elicited are similar to those of spontaneous labor and this is an advantage of amniotomy.

Page Ref: 633

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

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Learning Outcome: 3 Discuss the use of amniotomy in current maternal-newborn care.

MNL LO: 3.5.1 Discuss methods of labor induction and augmentation including implications for nursing care.

8) A laboring clients obstetrician has suggested amniotomy as a method for creating stronger contractions and facilitating birth. The client asks, What are the advantages of doing this? What should the nurse cite in response?

1. Contractions elicited are similar to those of spontaneous labor.

2. Amniotomy decreases the chances of a prolapsed cord.

3. Amniotomy reduces the pain of labor and makes it easier to manage.

4. The client will not need an episiotomy.

Answer: 1

Explanation: 1. Contractions after amniotomy are similar to those of spontaneous labor.

Page Ref: 633

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3 Discuss the use of amniotomy in current maternal-newborn care.

MNL LO: 3.5.1 Discuss methods of labor induction and augmentation including implications for nursing care.

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9) During a visit to the obstetrician, a pregnant client questions the nurse about the potential need for an amniotomy. The nurse explains that an amniotomy is performed to do which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Stimulate the beginning of labor

2. Augment labor progression

3. Allow application of an internal fetal electrode

4. Allow application of an external fetal monitor

5. Allow insertion of an intrauterine pressure catheter

Answer: 1, 2, 3, 5

Explanation: 1. Amniotomy is the artificial rupture of the amniotic membranes and can be used to induce labor.

2. Amniotomy can be done to augment labor.

3. Amniotomy allows access to the fetus in order to apply an internal fetal electrode to the fetal scalp.

5. Amniotomy may be performed during labor to allow an intrauterine pressure catheter to be inserted.

Page Ref: 633

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3 Discuss the use of amniotomy in current maternal-newborn care.

MNL LO: 3.5.1 Discuss methods of labor induction and augmentation including implications for nursing care.

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10) After inserting prostaglandin gel for cervical ripening, what should the nurse do?

1. Apply an internal fetal monitor.

2. Insert an indwelling catheter.

3. Withhold oral intake and start intravenous fluids.

4. Place the client in a supine position with a right hip wedge.

Answer: 4

Explanation: 4. After the gel, intravaginal insert, or tablet is inserted, the woman is instructed to remain lying down with a rolled blanket or hip wedge under her right hip to tip the uterus slightly to the left for the first 30 to 60 minutes to maintain the cervical ripening agent in place.

Page Ref: 627

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4 Compare methods of inducing labor, explaining their advantages and disadvantages.

MNL LO: 3.5.1 Discuss methods of labor induction and augmentation including implications for nursing care.

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11) Under which circumstances would the nurse remove prostaglandin from the clients cervix?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Contractions every 5 minutes

2. Nausea and vomiting

3. Uterine tachysystole

4. Cardiac tachysystole

5. Baseline fetal heart rate of 140-148

Answer: 2, 3, 4

Explanation: 2. A reason to remove prostaglandin from a clients cervix is the presence of nausea and vomiting.

3. A reason to remove prostaglandin from a clients cervix is uterine tachysystole.

4. A reason to remove prostaglandin from a clients cervix is cardiac tachysystole.

Page Ref: 627

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4 Compare methods of inducing labor, explaining their advantages and disadvantages.

MNL LO: 3.5.1 Discuss methods of labor induction and augmentation including implications for nursing care.

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12) The nurse knows that the Bishop scoring system for cervical readiness includes which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Fetal station

2. Fetal lie

3. Fetal presenting part

4. Cervical effacement

5. Cervical softness

Answer: 1, 4, 5

Explanation: 1. Fetal station is one of the components evaluated by the Bishop scoring system.

4. Cervical effacement is one of the components evaluated by the Bishop scoring system.

5. Cervical consistency is one of the components evaluated by the Bishop scoring system.

Page Ref: 628

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4 Compare methods of inducing labor, explaining their advantages and disadvantages.

MNL LO: 3.5.1 Discuss methods of labor induction and augmentation including implications for nursing care.

13) The nurse knows that a contraindication to the induction of labor is which of the following?

1. Placenta previa

2. Isoimmunization

3. Diabetes mellitus

4. Premature rupture of membranes

Answer: 1

Explanation: 1. Placenta previa is a contraindication to the induction of labor.

Page Ref: 626

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4 Compare methods of inducing labor, explaining their advantages and disadvantages.

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MNL LO: 3.5.1 Discuss methods of labor induction and augmentation including implications for nursing care.

14) Induction of labor is planned for a 31-year-old client at 39 weeks due to insulin-dependent diabetes. Which nursing action is most important?

1. Administer 100 mcg of misoprostol (Cytotec) vaginally every 2 hours.

2. Place dinoprostone (Prepidil) vaginal gel and ambulate client for 1 hour.

3. Begin Pitocin (oxytocin) 4 hours after 50 mcg misoprostol (Cytotec).

4. Prepare to induce labor after administering a tap water enema.

Answer: 3

Explanation: 3. Pitocin should not administered less than 4 hours after the last Cytotec dose.

Page Ref: 625

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4 Compare methods of inducing labor, explaining their advantages and disadvantages.

MNL LO: 3.5.1 Discuss methods of labor induction and augmentation including implications for nursing care.

15) The client presents for cervical ripening in anticipation of labor induction tomorrow. What should the nurse include in her plan of care for this client?

1. Apply an internal fetal monitor.

2. Monitor the client using electronic fetal monitoring.

3. Withhold oral intake and start intravenous fluids.

4. Place the client in a upright, sitting position.

Answer: 2

Explanation: 2. The client should be monitored using electronic fetal monitoring for at least 30 minutes and up to 2 hours after placement to assess the contraction pattern and the fetal status.

Page Ref: 626

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Compare methods of inducing labor, explaining their advantages and disadvantages.

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MNL LO: 3.5.1 Discuss methods of labor induction and augmentation including implications for nursing care.

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16) The nurse is explaining induction of labor to a client. The client asks what the indications for labor induction are. Which of the following should the nurse include when answering the client?

1. Suspected placenta previa

2. Breech presentation

3. Prolapsed umbilical cord

4. Hypertension

Answer: 4

Explanation: 4. A client with hypertension is appropriate for labor induction.

Page Ref: 626

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Compare methods of inducing labor, explaining their advantages and disadvantages.

MNL LO: 3.5.1 Discuss methods of labor induction and augmentation including implications for nursing care.

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17) A client at 40 weeks gestation is to undergo stripping of the membranes. The nurse provides the client with information about the procedure. Which information is accurate?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Intravenous administration of oxytocin will be used to initiate contractions.

2. The physician/CNM will insert a gloved finger into the cervical os and rotate the finger 360 degrees.

3. Stripping of the membranes will not cause discomfort, and is usually effective.

4. Labor should begin within 24-48 hours after the procedure.

5. Uterine contractions, cramping, and a bloody discharge can occur after the procedure.

Answer: 2, 4, 5

Explanation: 2. This motion separates the amniotic membranes that are lying against the lower uterine segment and internal os from the distal part of the lower uterine segment.

4. If labor is initiated, it typically begins within 24-48 hours.

5. Uterine contractions, cramping, scant bleeding, and bloody discharge can occur after stripping of the membranes.

Page Ref: 628, 629

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Compare methods of inducing labor, explaining their advantages and disadvantages.

MNL LO: 3.5.1 Discuss methods of labor induction and augmentation including implications for nursing care.

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18) The client is having fetal heart rate decelerations. An amnioinfusion has been ordered for the client to alleviate the decelerations. The nurse understands that the type of decelerations that will be alleviated by amnioinfusion is which of the following?

1. Early decelerations

2. Moderate decelerations

3. Late decelerations

4. Variable decelerations

Answer: 4

Explanation: 4. When cord compression is suspected, amnioinfusion (AI) may be considered. AI helps to prevent the possibility of variable decelerations by increasing the volume of amniotic fluid.

Page Ref: 635

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5 Discuss the use of transcervical intrapartum amnioinfusion.

19) In which clinical situations would it be appropriate for an obstetrician to order a labor nurse to perform amnioinfusion?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Placental abruption

2. Meconium-stained fluid

3. Polyhydramnios

4. Variable decelerations

5. Early decelerations

Answer: 2, 4

Explanation: 2. The physician may order amnioinfusion for meconium-stained fluid.

4. Amnioinfusion is sometimes done to prevent the possibility of variable decelerations.

Page Ref: 635

Cognitive Level: Analyzing

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5 Discuss the use of transcervical intrapartum amnioinfusion.

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20) The nurse is monitoring a client who is receiving an amnioinfusion. Which assessments must the nurse perform to prevent a serious complication?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Color of amniotic fluid

2. Maternal blood pressure

3. Cervical effacement

4. Uterine resting tone

5. Fluid leaking from the vagina

Answer: 2, 4, 5

Explanation: 2. Blood pressure should be monitored along with other vital signs.

4. The nurse should monitor contraction status (frequency, duration, intensity, resting tone, and associated maternal discomfort).

5. The nurse should continually check to make sure the infused fluid is being expelled from the vagina.

Page Ref: 635

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 1. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5 Discuss the use of transcervical intrapartum amnioinfusion.

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21) The nurse is completing discharge teaching for a client who delivered 2 days ago. Which statement by the client indicates that further information is required?

1. Because I have a midline episiotomy, I should keep my perineum clean.

2. I can use an ice pack to relieve some the pain from the episiotomy.

3. I can take ibuprofen (Motrin) when my perineum starts to hurt.

4. The tear I have through my rectum is unrelated to my episiotomy.

Answer: 4

Explanation: 4. This statement is incorrect. The major disadvantage is that a tear of the midline incision may extend through the anal sphincter and rectum.

Page Ref: 636

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 1. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6 Describe the types of episiotomies performed, the rationale for each, and the associated nursing interventions.

MNL LO: 3.5.3 Examine management of the woman undergoing an operative vaginal delivery.

22) The client requires vacuum extraction assistance. To provide easier access to the fetal head, the physician cuts a mediolateral episiotomy. After delivery, the client asks the nurse to describe the episiotomy. What does the nurse respond?

1. The episiotomy goes straight back toward your rectum.

2. The episiotomy is from your vagina toward the urethra.

3. The episiotomy is cut diagonally away from your vagina.

4. The episiotomy extends from your vagina into your rectum.

Answer: 3

Explanation: 3. A mediolateral episiotomy is angled from the vaginal opening toward the buttock. It begins in the midline of the posterior fourchette and extends at a 45-degree angle downward to the right or left.

Page Ref: 636

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6 Describe the types of episiotomies performed, the rationale for each, and the a

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ssociated nursing interventions.

MNL LO: 3.5.3 Examine management of the woman undergoing an operative vaginal delivery.

23) The client is recovering from a delivery that included a midline episiotomy. Her perineum is swollen and sore. Ten minutes after an ice pack is applied, the client asks for another. What is the best response from the nurse?

1. Ill get you one right away.

2. You only need to use one ice pack.

3. You need to leave it off for at least 20 minutes and then reapply.

4. Ill bring you an extra so that you can change it when you are ready.

Answer: 3

Explanation: 3. For optimal effect, the ice pack should be applied for 20 to 30 minutes and removed for at least 20 minutes before being reapplied.

Page Ref: 637

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Teaching and Learning

Learning Outcome: 6 Describe the types of episiotomies performed, the rationale for each, and the associated nursing interventions.

MNL LO: 3.5.3 Examine management of the woman undergoing an operative vaginal delivery.

24) Major perineal trauma (extension to or through the anal sphincter) is more likely to occur if what type of episiotomy is performed?

1. Mediolateral

2. Episiorrhaphy

3. Midline

4. Medical

Answer: 3

Explanation: 3. Major perineal trauma is more likely to occur if a midline episiotomy is performed. The major disadvantage is that a tear of the midline incision may extend through the anal sphincter and rectum.

Page Ref: 636

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Quality and Safety: Communicate potential risk factors and

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actual errors. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6 Describe the types of episiotomies performed, the rationale for each, and the associated nursing interventions.

MNL LO: 3.5.3 Examine management of the woman undergoing an operative vaginal delivery.

25) A client attending a prenatal class asks why episiotomies are performed. The nurse explains that risk factors that predispose women to episiotomies include which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Large or macrosomic fetus

2. Use of forceps

3. Shoulder dystocia

4. Maternal health

5. Shorter second stage

Answer: 1, 2, 3

Explanation: 1. A large fetus places a woman at risk for an episiotomy to prevent lacerations.

2. Use of forceps or vacuum extractor is a risk factor that predisposes women to episiotomies.

3. Shoulder dystocia is a risk factor that predisposes women to episiotomies.

Page Ref: 636

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6 Describe the types of episiotomies performed, the rationale for each, and the associated nursing interventions.

MNL LO: 3.5.3 Examine management of the woman undergoing an operative vaginal delivery.

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26) The nurse is training a nurse new to the labor and delivery unit. They are caring for a laboring client who will have a forceps delivery. Which action or assessment finding requires intervention?

1. Regional anesthesia is administered via pudendal block.

2. The client is instructed to push between contractions.

3. Fetal heart tones are consistently between 110 and 115.

4. The clients bladder is emptied using a straight catheter.

Answer: 2

Explanation: 2. During the contraction, as the forceps are applied, the woman should avoid pushing.

Page Ref: 639

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: QSEN Competencies: V. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. | AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network. | NLN Competencies: Quality and Safety: Communicate effectively with different individuals (team members, other care providers, patients, families, etc.) so as to minimize risks associated with handoffs among providers and across transitions in care. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7 Summarize the indications for forceps-assisted birth, types of forceps that may be used, complications, and related interventions.

MNL LO: 3.5.3 Examine management of the woman undergoing an operative vaginal delivery.

27) The need for forceps has been determined. The clients cervix is dilated to 10 cm, and the fetus is at +2 station. What category of forceps application would the nurse anticipate?

1. Input

2. Low

3. Mid

4. Outlet

Answer: 2

Explanation: 2. Low forceps are applied when the leading edge of the fetal head is at +2 station.

Page Ref: 638

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7 Summarize the indications for forceps-assisted birth, types of forceps that may be used, complications, and related interventions.

MNL LO: 3.5.3 Examine management of the woman undergoing an operative vaginal delivery.

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28) What type of forceps are designed to be used with a breech presentation?

1. Midforceps

2. Piper

3. Low

4. High

Answer: 2

Explanation: 2. Piper forceps are designed to be used with a breech presentation. They are applied after the birth of the body, when the fetal head is still in the birth canal and assistance is needed.

Page Ref: 637

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 7 Summarize the indications for forceps-assisted birth, types of forceps that may be used, complications, and related interventions.

MNL LO: 3.5.3 Examine management of the woman undergoing an operative vaginal delivery.

29) The physician has determined the need for forceps. The nurse should explain to the client that the use of forceps is indicated because of which of the following?

1. Her support person is exhausted

2. Premature placental separation

3. To shorten the first stage of labor

4. To prevent fetal distress

Answer: 2

Explanation: 2. Fetal conditions indicating the need for forceps include premature placental separation, prolapsed umbilical cord, and nonreassuring fetal status.

Page Ref: 638

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7 Summarize the indications for forceps-assisted birth, types of forceps that may be used, complications, and related interventions.

MNL LO: 3.5.3 Examine management of the woman undergoing an operative vaginal delivery.

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30) The physicians/CNM opts to use a vacuum extractor for a delivery. What does the nurse understand?

1. There is little risk with vacuum extraction devices.

2. There should be further fetal descent with the first two pop-offs.

3. Traction is applied between contractions.

4. The woman often feels increased discomfort during the procedure.

Answer: 2

Explanation: 2. If more than three pop-offs occur (the suction cup pops off the fetal head), the procedure should be discontinued.

Page Ref: 641

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 8 Discuss the use of vacuum extraction, including indications, procedure, complications, and related nursing management.

MNL LO: 3.5.3 Examine management of the woman undergoing an operative vaginal delivery.

31) The client has been pushing for 2 hours and is exhausted. The physician is performing a vacuum extraction to assist the birth. Which finding is expected and normal?

1. The head is delivered after eight pop-offs during contractions.

2. A cephalohematoma is present on the fetal scalp.

3. The location of the vacuum is apparent on the fetal scalp after birth.

4. Positive pressure is applied by the vacuum extraction during contractions.

Answer: 3

Explanation: 3. The parents need to be informed that the caput (chignon) on the babys head will disappear within 2 to 3 days.

Page Ref: 642

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 8 Discuss the use of vacuum extraction, including indications, procedure, complications, and related nursing management.

MNL LO: 3.5.3 Examine management of the woman undergoing an operative vaginal delivery.

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Copyright 2016 Pearson Education, Inc.

32) The client has been pushing for two hours, and is exhausted. The fetal head is visible between contractions. The physician informs the client that a vacuum extractor could be used to facilitate the delivery. Which statement indicates that the client needs additional information about vacuum extraction assistance?

1. A small cup will be put onto the babys head, and a gentle suction will be applied.

2. I can stop pushing and just rest if the vacuum extractor is used.

3. The babys head might have some swelling from the vacuum cup.

4. The vacuum will be applied for a total of ten minutes or less.

Answer: 2

Explanation: 2. Vacuum extraction is an assistive delivery. The physician/CNM applies traction in coordination with uterine contractions.

Page Ref: 639

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 8 Discuss the use of vacuum extraction, including indications, procedure, complications, and related nursing management.

MNL LO: 3.5.3 Examine management of the woman undergoing an operative vaginal delivery.

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Copyright 2016 Pearson Education, Inc.

33) The laboring client participated in childbirth preparation classes that strongly discouraged the use of medications and intervention during labor. The client has been pushing for two hours, and is exhausted. The physician requests that a vacuum extractor be used to facilitate the birth. The client first states that she wants the birth to be normal, then allows the vacuum extraction. Following this, what should the nurse assess the client for after the birth?

1. Elation, euphoria, and talkativeness

2. A sense of failure and loss

3. Questions about whether or not to circumcise

4. Uncertainty surrounding the babys name

Answer: 2

Explanation: 2. Clients who participate in childbirth classes that stress the normalcy of birth may feel a sense of loss or failure if an intervention is used during their labor or birth.

Page Ref: 639

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 13. Acknowledge the tension that may exist between patient rights and the organizational responsibility for professional, ethical care. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 8 Discuss the use of vacuum extraction, including indications, procedure, complications, and related nursing management.

MNL LO: 3.5.3 Examine management of the woman undergoing an operative vaginal delivery.

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Copyright 2016 Pearson Education, Inc.

34) The nurse is reviewing charts of clients who underwent cesarean births by request in the last two years. The hospital is attempting to decrease costs of maternity care. What findings contribute to increased health care costs in clients undergoing cesarean birth by request?

1. Increased abnormal placenta implantation in subsequent pregnancies

2. Decreased use of general anesthesia with greater use of epidural anesthesia

3. Prolonged anemia, requiring blood transfusions every few months

4. Coordination of career projects of both partners leading to increased income

Answer: 1

Explanation: 1. Repeat cesarean births are associated with greater risks including increased incidence of abnormal placentation in subsequent pregnancies and the increased risk of mortality secondary to surgery, which would contribute to increased health care costs.

Page Ref: 646

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: V. 10. Articulate, through a nursing perspective, issues concerning healthcare delivery to decision makers within healthcare organizations and other policy arenas. | NLN Competencies: Knowledge and Science: Translate research into practice in order to promote quality and improve practices. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 9 Explain the indications for cesarean birth, impact on the family unit, preparation and teaching needs, and associated nursing management.

MNL LO: 3.5.2 Explain the management of the childbearing family undergoing a cesarean birth.

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Copyright 2016 Pearson Education, Inc.

35) After being in labor for several hours with no progress, a client is diagnosed with CPD (cephalopelvic disproportion), and must have a cesarean section. The client is worried that she will not be able to have any future children vaginally. After sharing this information with her care provider, the nurse would anticipate that the client would receive what type of incision?

1. Transverse

2. Infraumbilical midline

3. Classic

4. Vertical

Answer: 1

Explanation: 1. The transverse incision is made across the lowest and narrowest part of the abdomen and is the most common lower uterine segment incision.

Page Ref: 643

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 9 Explain the indications for cesarean birth, impact on the family unit, preparation and teaching needs, and associated nursing management.

MNL LO: 3.5.2 Explain the management of the childbearing family undergoing a cesarean birth.

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Copyright 2016 Pearson Education, Inc.

36) The client demonstrates understanding of the implications for future pregnancies secondary to her classic uterine incision when she states which of the following?

1. The next time I have a baby, I can try to deliver vaginally.

2. The risk of rupturing my uterus is too high for me to have any more babies.

3. Every time I have a baby, I will have to have a cesarean delivery.

4. I can only have one more baby.

Answer: 3

Explanation: 3. A classic uterine incision is made in the upper uterine segment and is associated with an increased risk of rupture in subsequent pregnancy, labor, and birth. Therefore, subsequent deliveries will be done by cesarean.

Page Ref: 643

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 9 Explain the indications for cesarean birth, impact on the family unit, preparation and teaching needs, and associated nursing management.

MNL LO: 3.5.2 Explain the management of the childbearing family undergoing a cesarean birth.

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Copyright 2016 Pearson Education, Inc.

37) In the operating room, a client is being prepped for a cesarean delivery. The doctor is present. What is the last assessment the nurse should make just before the client is draped for surgery?

1. Maternal temperature

2. Maternal urine output

3. Vaginal exam

4. Fetal heart tones

Answer: 4

Explanation: 4. Ascertain fetal heart rate (FHR) before surgery and during preparation because fetal hypoxia can result from aortocaval compression.

Page Ref: 644

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 9 Explain the indications for cesarean birth, impact on the family unit, preparation and teaching needs, and associated nursing management.

MNL LO: 3.5.2 Explain the management of the childbearing family undergoing a cesarean birth.

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Copyright 2016 Pearson Education, Inc.

38) A prenatal client asks the nurse about conditions that would necessitate a cesarean delivery. The nurse explains that cesarean delivery generally is performed in the presence of which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Complete placenta previa

2. Placental abruption

3. Umbilical cord prolapse

4. Precipitous labor

5. Failure to progress

Answer: 1, 2, 3, 5

Explanation: 1. When the placenta completely covers the uterine opening, a cesarean is performed.

2. Premature separation of the placenta from the uterine wall requires an immediate cesarean.

3. A prolapsed cord is an emergency requiring an immediate cesarean.

5. Failure to progress in labor can necessitate a cesarean birth.

Page Ref: 642

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 9 Explain the indications for cesarean birth, impact on the family unit, preparation and teaching needs, and associated nursing management.

MNL LO: 3.5.2 Explain the management of the childbearing family undergoing a cesarean birth.

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Copyright 2016 Pearson Education, Inc.

39) A client is consulting a certified nurse-midwife because she is hoping for a vaginal birth after cesarean (VBAC) with this pregnancy. Which statement indicates that the client requires more information about VBAC?

1. I can try a vaginal birth because my uterine incision is a low segment transverse incision.

2. The vertical scar on my skin doesnt mean that the scar on my uterus goes in the same direction.

3. There is about a 90% chance of giving birth vaginally after a cesarean.

4. Because my hospital has a surgery staff on call 24 hours a day, I can try a VBAC there.

Answer: 3

Explanation: 3. Women whose previous cesarean was performed because of nonrecurring indications have been reported to have approximately a 60% to 80% chance of success with VBAC.

Page Ref: 646

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 10 Examine the risks, guidelines, and nursing care of the woman undergoing vaginal birth after cesarean birth (VBAC) or a trial of labor after cesarean birth (TOLAC).

MNL LO: 3.5.3 Examine management of the woman undergoing an operative vaginal delivery.

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Copyright 2016 Pearson Education, Inc.

40) The nurse is teaching a class on vaginal birth after cesarean (VBAC). Which statement by a participant indicates that additional information is needed?

1. Because the scar on my belly goes down from my navel, I am not a candidate for a VBAC.

2. My first baby was in a breech position, so for this pregnancy, I can try a VBAC if the baby is head-down.

3. Because my hospital is so small and in a rural area, they wont let me attempt a VBAC.

4. The rate of complications from VBAC is lower than the rate of complications from a cesarean.

Answer: 1

Explanation: 1. Skin incision is not indicative of uterine incision. Only the uterine incision is a factor in deciding whether VBAC is advisable. The classic vertical incision was commonly done in the past and is associated with increased risk of uterine rupture in subsequent pregnancies and labor.

Page Ref: 643

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 10 Examine the risks, guidelines, and nursing care of the woman undergoing vaginal birth after cesarean birth (VBAC) or a trial of labor after cesarean birth (TOLAC).

MNL LO: 3.5.3 Examine management of the woman undergoing an operative vaginal delivery.

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